Medical services

Insured (covered) services

The Medical Services Program is a universal program, which means that anyone covered by the Health Insurance Plan is eligible. To benefit from this program, just present your valid Health Insurance Card.

The medical services insured (or covered) by the Health Insurance Plan are those that are medically necessary and rendered by a general practitioner (also called a "family doctor") or a medical specialist. These services include:

examinationsExamination
Usually consists of a questionnaire and a physical examination designed to enable the doctor to evaluate a person's state of health.

consultationsConsultation
An examination of a patient carried out at the request of another doctor.

diagnostic proceduresDiagnostic procedures
Procedures used by a doctor to evaluate a person's state of health and to determine the health problem in question.

therapeutic proceduresTherapeutic procedures
Procedures used by a doctor to treat a disease.

psychiatric treatments

surgery

anesthesia

certain radiology services provided by a doctor

Barring rare exceptions, the above services are covered regardless of where they are rendered, for instance in:

Medical services covered under special authorization

Services rendered only for cosmetic reasons are not covered by the Health Insurance Plan. Doctors must therefore determine whether a requested service is or is not medically necessary.

Here are some examples:

lipectomy (surgery to remove fatty tissue and surplus skin)

blepharoplasty (excision of any excess eyelid tissue)

electrolysis to correct hirsutism (excessive pilosity of the male type in women)

correction of a scar elsewhere than on the face or neck

capillary grafts required as a result of trauma

Consult your doctor to find out whether the desired service is covered by the Health Insurance Plan since authorization from the Régie must be obtained before providing the service.

Medical services covered outside Québec

The Health Insurance Plan covers a wide range of essential medical services. However, in exceptional cases, some services may not be offered in Québec. In such cases, your doctor can request the Régie's authorization to receive healthcare outside Québec.

How to proceed

Your doctor must provide the Régie with the following:

a brief description of the medical care required

a written request signed by 2 Québec medical specialists having recognized expertise in the disease from which you suffer and attesting that the services required are not available in Québec

the name of the doctor whose services are required and the address of the hospital where he/she practices (the hospital being recommended)

a summary of your medical record

The Régie's decision

The Régie will evaluate the request and inform you and your medical specialists of its decision. If the Régie grants an authorization, it will pay the full cost of:

hospital services (services related to a hospital stay, such as nursing care and accommodation)

professional services rendered in a hospital setting (such as the services of a doctor)

Medical services covered during the waiting period eligibility

Generally speaking, if you arrive in Québec from outside Canada to settle in Québec, even if you are a Canadian citizen, you will be eligible for the Québec Health Insurance Plan after a waiting period of up to 3 months following your registration.

The Régie does not reimburse you for healthcare you receive during the waiting period. To save you from having to pay for any healthcare services that your family members may need, the Régie strongly recommends that you take out private insurance within 5 days following your arrival in Québec. Thereafter, coverage is more difficult to obtain. For information about private insurance, contact the OmbudService for Life & Health Insurance (OLHI).

Pending receipt of your Health Insurance Card , be sure to keep the letter indicating that you are subject to a waiting period, because some healthcare services are available free of charge to persons waiting for their coverage to take effect, such as services:

needed by victims of conjugal or domestic violence or of sexual assault

related to pregnancy, child birth or termination of pregnancy

needed by people suffering from infectious diseases that have an impact on public health

Non-insured (non-covered) services

Medical services not necessary or required are not covered by the Health Insurance Plan. You cannot present your Health Insurance Card to receive them. You must pay for these services on your own. Non-covered services include:

services rendered for cosmetic reasons

acupuncture

treatment of varicose veins by injection and the examination made at that time, in a private medical office

psycho-analysis (except when rendered in a facility authorized for this purpose by the Minister of Health and Social Services)

consultations by phone, fax, email or regular mail

If you see a doctor and undergo examinations for the sole purpose of obtaining a certificate attesting to your state of health, you are required to pay for these services. They are not covered because they are not related to preventing or curing an illness. They include medical visits and examinations for the following reasons:

obtaining or renewing an insurance policy

starting or holding a job (unless the examination is required under a Québec law other than the Act respecting collective agreement decrees)

being admitted to an educational institution, an association, an organization, a summer camp, a health centre, a sports club, a daycare centre or a recreational service

being assessed for the ends of justice

Participating or non-participating physicians

Most doctors accept the Health Insurance Card as payment for their fees. They are known as participating physicians and are subject to the application of an agreement between their professional federation and the Ministère de la Santé et des Services sociaux. The Régie remunerates them for the covered health services they render to their patients.

Some doctors do not participate in the Québec Health Insurance Plan. They are known as non-participating physicians. They do not accept the Health Insurance Card as payment for their services and are not remunerated by the Régie. They bill their patients directly and set their own rates. The Régie is not able to issue reimbursements for the cost of their services.